Dental Procedures As Risk Factors For Prosthetic Hip Or Knee Infection: A Hospital
Presented in part: 18th Annual Open Scientific Meeting of the Musculoskeletal Infection Society, 9 August 2008 and the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America Meeting, 2328 October 2008 .
Clinical Infectious DiseasesClinical Infectious Diseases
Briglia Dental Cares About Your Health
Your health, recovery, and peace of mind are important to us. Before going in for joint replacement surgery, a dental health clearance can really make a difference in the outcome of the procedure. It will protect your new joint and the incision area, along with lowering your risk of other problems throughout the body. We can help you get treated properly and decrease the risk of complications.
To schedule an appointment with Briglia Dental Group, call us at .
Editors Note: This post was originally published in November 2017 and has been updated for accuracy and comprehensiveness.
Hip Replacement Surgery Checklist
Hip replacement surgery involves a long recovery time to allow your body to heal. Learn about steps to take before the procedure to keep you healthy and minimize post-op problems.
Undergoing a hip replacement is a major surgery, so its important to prepare beforehand to increase your chances of a successful outcome and reduced hip pain.
Before Hip Replacement Surgery: Working With Your Orthopedist
The most important thing you can do before surgery is to make sure you are comfortable with your orthopedic surgeon.
You need a doctor you can talk to and trust to get a sense of where things are, advises Steven Stuchin, MD, director of orthopedic surgery at the Hospital for Joint Diseases of New York University Medical Center and associate professor at the NYU School of Medicine in New York City.
Because you will most likely go through years of follow-up, choose a surgeon you feel you’ll be able to work with for a long time.
Before Hip Replacement Surgery: Medical Evaluation
Prior to your hip replacement, you will be evaluated by your primary care doctor to make sure you are healthy enough for surgery. This evaluation might include an electrocardiogram, chest X-ray, and blood tests, and making sure chronic conditions such as asthma or high blood pressure are under control. Your medical doctor will use this information to determine whether you’re at high risk for complications due to surgery.
Before Hip Replacement Surgery: Blood Transfusion
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When To See A Doctor
A person should see their dentist at the first sign of a tooth infection. Early treatment will help prevent the infection from spreading into other tissues.
A tooth infection that has spread is a medical emergency. Such infections can quickly become widespread and severe. Systemic infections can be life threatening.
A person should contact a dentist for an emergency appointment as soon as possible. If there are no dentists available, a person should visit the emergency department of their nearest hospital.
A dentist or doctor will provide treatments to target the infection and stop it from spreading further.
The type of treatment that a person receives for a tooth infection will depend on several factors, including:
- the initial location of the abscess
- whether, and to what extent, the infection has spread
- the extent of the immune systems reaction to the infection
Possible treatments for a tooth infection include those below.
Visit Your Dentist First Before Considering Joint Replacement
Joint replacement is a remarkable medical procedure that is becoming routine in our time. Just think of that phrase joint replacement. The fact that surgically a failing knee, shoulder or hip can be removed and replaced is something to marvel at.
I recommend that anyone considering joint replacement therapy visit their dentist for a careful examination and screening for periodontal disease or any other type of infection that may be present and could contribute to joint complications or failure. It seems like a small price to pay to eliminate a large potential threat to new joints but also to your health in general. Many orthopedic surgeons are diligent with their patient care and will not do the surgery until theyve seen a dentist and are certain that there is no infection present in the mouth. I just had a patient in today that had two abscessed teeth and seeking treatment to eliminate this infection because of a pending knee replacement surgery next month. She actually said Ive been waiting 10 years to get this knee replaced Im not taking any chances that it will fail!
Periodontal disease is silent and if unchecked can slowly progress and as weve seen be harmful to more than just your teeth. If you are uncertain make an appointment with your Dental professional and have a thorough examination of your teeth and gum structures.
Dr. Charles McCarroll, DDS
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Did His Artificial Hips Put Him At Risk Of Infection When He Saw The Dentist
Joint replacement is among the most reliable of common surgeries. Since getting my left hip replaced seven years ago and my right hip a couple of years after that and following up with physical therapy so I could relearn how to walk like a regular person I hardly ever think about the fact that I have metal and plastic where bone used to be.
Except when I go to the dentist.
For years, people with artificial joints have been told they should take a single large dose of an antibiotic one hour before any dental treatment, whether a routine teeth cleaning or an invasive root canal procedure.
The reasoning is simple: Your mouth is filled with bacteria, and when the dentist or hygienist starts poking around, some of those bacteria can get into your bloodstream. If they travel to an artificial joint and take up residence, they can form a biofilm on the metal or plastic parts. Biofilms are very tenacious and can ruin the joint, forcing a new surgery to replace it, says Helen Boucher, a professor of infectious diseases at Tufts Medical Center in Boston. Taking a dose of antibiotics before dental treatment is supposed to kill off any stray bacteria, reducing the chances of this unpleasant outcome.
Current guidelines from the American Academy of Orthopaedic Surgeons say that orthopedists might consider discontinuing routine prescription of antibiotics before dental procedures. The wording may be judicious, but its unhelpful to someone trying to reach a thoughtful decision.
Why Consider Knee Joint Replacement And Hip Joint Replacement Surgery
Any type of infection in other areas of the body can also lead to the infection of the hip or knee replacements. Infections are caused by viruses or bacteria. Although bacteria are abundant on our skin and the gastrointestinal tract, the immune system works hard and generally keeps the harmful bacteria in check. For example, if bacteria ventures into the bloodstream, the natural immune system kicks in quickly to kill the invading, harmful bacteria.
However, hip and knee joint replacements are made from plastic or metal which the body sees as a foreign object making it difficult for the immune system to attack all of the bacteria that makes it to the area surrounding the implants. If bacteria gain access to the implants, they may multiply and cause an infection. Despite the advancements in preventative treatments and antibiotics, patients with an infection of the joint replacement more often than not, require surgery in order to cure the infection.
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How To Decrease The Risk Of Joint Replacement Infections
About 1 million total joint replacement surgeries mostly hips and knees are performed each year across the country. In most cases, the new prosthetic hip or knee offers significant pain relief and, with regular physical therapy, patients can get back to their daily life quickly. In about 1% of cases, however, patients develop a deep infection.
Bacteria can enter the joint during the procedure, even in a sterile operating room, or after it, as the incision heals. A third option is that bacteria already present in the patients body travel through the blood to the site of the prosthesis. This is the type of infection that doctors and dentists are working together to prevent.
Treatment Of Joint Infection
Treatment is easy when caught early to a superficial infection or infections just affecting the soft tissues of the joint or the skin but not yet has deep down into the artificial joint itself. Treatments include oral antibiotics or intravenous antibiotics both routes have a high success rate. For an infection that gains a deeper access into the body and hits the joint itself, more times than not, require beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.
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Side Effects Of Antibiotic Prophylaxis
It has been estimated that routine prophylaxis with oral penicillin in one million hypothetical patients with total joint arthroplasty undergoing dental treatment would result in 400 cases of anaphylaxis . This suggests that the risk-benefit ratio for beta-lactam prophylactic antibiotics may not be favorable . Antibiotic use may also be associated with risks such as toxicity, superinfection, selection of antibiotic resistance, pseudomembranous colitis, cross-reactions with other drugs and death .
Why Your Dental Health Matters
Researchers are increasingly uncovering the role that your dental health plays in your overall health. As examples, one study found that those who brush their teeth fewer than two times a day and for less than two minutes were three times more likely to develop heart disease. Another study found a link between periodontitis and dementia.
The reason why these areas of your health are connected is that when you have gum disease, harmful bacteria can enter your bloodstream. This is an overly simplistic explanation for a complex issue, but it gives you a basic idea of what were up against.
While periodontitis is one of the primary culprits, any time you have an infection in your mouth, such as a root canal infection or even dental caries , it means that infection-causing bacteria are present in your system.
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Causes Of Joint Infection
A total joint can possibly become infected starting at the time of surgery, or can range from a few short weeks after or up to several years after recovery time is over and the surgery is completed. Common ways that bacteria can enter the body includes minor cuts or breaks in the skin, root canals, tooth extractions or other major dental procedures, and through wounds that are the result of other surgical procedures.
Certain people will face a higher risk for developing infections after any surgical procedure including a joint replacement procedure. Factors that will play a role in the increase the risk of infection includes:
- Diabetes mellitus
- Fevers, night sweats, and chills
- Fatigue
The Importance Of Good Dental Health Before Your Orthopaedic Surgery
While you may think theres little connection between your teeth and gums and your hip joint, there are times when these two areas of your health meet. More specifically, if youre planning to undergo hip replacement surgery, we recommend that you get cleared by your dentist beforehand to lower your risk for postoperative infection.
At Western Orthopaedics, our hip specialist, Dr. Brian White, understands that your road to deciding to replace your hip joint was a tough and painful one. Our goal is to put an end to your discomfort, so we want to make sure that everything goes as smoothly as possible. As part of this effort, ensuring that your teeth and gums are infection-free certainly helps.
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Joint Replacement Surgery & Infection Treatment
Two of the most commonly performed elective surgeries or operations are the hip and knee replacement surgeries. Joint replacement surgery, for the majority of patients, will lead to a more active, pain-free life. However, like with any surgical procedure, there will be risks involved.
Although it is not common, there is a chance of infection stemming from the surgery that some patients might face. Infections can be deep and internal, surrounding the artificial implant, or can be seen on the superficial level through wounds. An infection, whether its superficial or on a deeper level may develop as early as the duration of the hospital visit or arise shortly after being released while home. Infections can happen to the joint replacement infection even years after the surgery.
If You’ve Had Joint Replacement You May Need Antibiotics Before Dental Work
If youve had a total joint replacement or similar procedure, you will want your surgeon to decide if you need to take an antibiotic before you undergo dental work. This is a precaution to prevent a serious infection known as bacteremia.
Bacteremia occurs when bacteria become too prevalent in the bloodstream and cause infection in other parts of the body, especially in joints and bone with prosthetic substances. Its believed that during invasive dental procedures bacteria in the mouth can enter the bloodstream through incisions and other soft tissue disruptions.
Joint infections are a serious matter and can require extensive therapy to bring it under control. Out of this concern, the use of antibiotics as a prophylactic against bacteremia once included a wide range of patients for a variety of conditions and procedures. But after an in-depth study in 2007, the American Dental Association concluded that the risks for many of these patient groups for infection triggered by a dental procedure was extremely low and didnt warrant the use of antibiotic premedication therapy.
The guidelines for antibiotic premedication can be complex. Its best, then, to speak with both your orthopedic surgeon and us about whether you should undergo antibiotic therapy before you undergo a dental procedure. The ultimate goal is to reduce the risks of any disease and to keep both your mouth and your body safe from infection.
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Prevention Of Joint Infection
Take note of these measures below to minimize the risk of infection from the beginning and early phases of the original joint replacement surgery. These steps help a lot to lower the risk leading to an infection even without a scientifically proven method. The most important known measures to lower the risk of infection after total joint replacement include:
- Antibiotics before and after surgery
- Preoperative chlorhexidine wash
- Short operating time and minimal operating room traffic
- Antibiotic prophylaxis
- Preoperative nasal screening for bacterial colonization
- Use of strict sterile technique and sterilization instruments
Tooth Infection Before Hip Replacement
- #1 11-15-2016 03:11 PM by LamiMikeI’m scheduled for a left hip replacement on the Nov 21 next Monday, and I just found out a few days ago I have a infection in my tooth. I’ve been on antibiotic,s for three days counting today. Should I be fine for my hip surgery, on Monday?Thanks, Mike
- 11-17-2016 06:42 PM by Silver SwanRe: tooth infection before hip replacementI’m scheduled for a left hip replacement on the Nov 21 next Monday, and I just found out a few days ago I have a infection in my tooth. I’ve been on antibiotic,s for three days counting today. Should I be fine for my hip surgery, on Monday?Thanks, MikeHi Mike:Gee if I were you I sure would contact the hip surgeon about whether you should go ahead with the surgery at this time since you have had a tooth infection. The surgeon is really the only person who can make this decision. My own opinion is that it would be wise to postpone the hip surgery till you are completely over this current tooth infection. Let us know how this turns out!
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To What Extent Do We Find Staphylococci In The Oral Cavity
There is considerable controversy as to whether Staphylococcus species play a role in the ecology of the normal oral flora, and there is surprisingly little knowledge on the role of staphylococci in oral health and disease. It has been claimed that S. aureus and S. epidermidis constitute only 0.005% of the oral microbiota . However, a growing body of evidence suggests that staphylococci can be isolated more frequently from the oral cavity of some patient groups such as children , elderly , terminally ill patients , rheumatoid arthritis patients , and patients with hematological malignancies . Therefore, the oral cavity may represent a hitherto poorly recognized reservoir of staphylococci, which under the right conditions may cause local or systemic infection .
Significantly higher proportions of staphylococci were recovered from periimplantitis lesions compared to gingivitis and periodontitis , and it was suggested that staphylococci may play a role in some failing osseointegrated dental implants . Another study with 37 patients with failing implants detected staphylococci, organisms associated with the gut and Candida species in 55% of peri-implant lesions and almost as frequently as periodontopathogens . Implants surrounded by healthy periodontium had a microflora compatible with microbial health.
S. aureus has further been recovered from jaw cysts and oral mucosal lesions .
Premedication No Longer Recommended For Most Joint Replacement Patients
A Report from the American Dental Association Council on Scientific Affairs has determined that the use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints is no longer warranted for most people.
Clinical Recommendations:New Guidelines for the Use of Prophylactic Antibiotics in Patient with Prosthetic Joints
In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection.
For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. To assess a patients medical status, a complete health history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.
Clinical Reasoning for the Recommendation:
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